CR99. Suicide in prisons

Suicide in prisons is the Royal College of
Psychiatrists' response to a Thematic Review on this subject
produced by HM Chief Inspector of Prisons for England and Wales
(1999) called "Suicide is Everyone's' Concern".

The College takes a clinical approach to the prevention of suicide
and the treatment of suicidal thinking. It is emphasized throughout
that to carry out the recommendations, new resources will be
required. More beds and more staff are required in the NHS. More
and differently trained staff are required in the prison service.
Unless services are resourced they are not services at
all.

The commonest method of suicide in prison is
asphyxiation, usually at night. The high risk factors for suicide
among prisoners are similar to those among other citizens: youth,
male sex, depression, alcoholism, and loss of a relative, friend or
partner.

The Thematic Review implies that suicide rates are higher in prison
than might be expected. The College accepts that suicide rates in
prison are very high - too high - but they are not necessarily
higher than can be expected given the vulnerable nature of the
individuals, at high risk of suicide, who are sent to prison.

The College emphasises the importance of making accurate diagnoses,
if applicable, in all prisoners, and noting the significance of
multiple diagnoses. Every prison should have a comprehensive
primary care service with a secondary care community mental health
team operating within the prison. It recommends that community drug
teams should have access to prisoners and that all prison doctors
should receive specific training in psychiatric and in drug abuse
medicine.

Like the Chief Inspector, the College does not believe that prisons
are suitable environments for people under the age of 18 years.
Offenders below this age should be admitted to specialised
institutions. The College also recommends that anti-bullying
programmes should be mandatory in all prisons.

The Chief Inspector draws favourable attention to prisoner
participation observation schemes for suicide prevention. The
College agrees and suggests that several schemes be
considered.

The Thematic Review concludes with a chapter on healthy prisons,
which is strongly endorsed by the College. The Chief Inspector's
key constituents for healthy prison are a safe environment,
treating people with respect, a full constructive and purposeful
regime, and resettlement training to prevent re-offending.

Overall the Royal College of Psychiatrists welcomes the Thematic
Review, but stresses further points:

Too many mentally disordered people are being sent to
prison.

There is a need for a more appropriate model of mental
healthcare delivery within prisons. There is a need for better
screening for suicidal ideas and propensities at reception and for
further assessment and treatment.

There are inadequate treatment facilities for mentally
disordered offenders outside of prison, and mental health services
in the community need to be amplified so they can play a bigger
role in the care of mentally disordered offenders.

NHS authorities need to provide more beds for acute psychiatric
care, to make court diversion schemes a practical possibility.

There needs to be a greater provision of secure beds in the
NHS.

There needs to be more and better liaison between the prison
health care service and the NHS.

As an aside, the College response draws attention to the fact
that the whole of the criminal justice system, not just the
prisons, is implicated in the mental health problems seen in
prisons and that judges and other lawyers should learn more about
psychiatry, psychology and criminology.

The Royal College concludes by emphasising the mental hygiene issue
of socialisation, which is so difficult in prisons, and the
importance of ensuring that mentally distressed people are not kept
in isolation. Special attention is drawn to the need for all
suicidal prisoners to be in close contact with other people.